When the original direct entry midwife law was first proposed in 2005, I initially opposed it. Like most obstetricians, I have seen many episodes when immediate medical intervention saved a woman or baby's life. When things go wrong in obstetrics, they go wrong suddenly. Minutes make a difference. That's why most physicians oppose home births.
UMA, with the help of ACOG, extensively researched the safety of home births and found mixed results. We found the underlying factors in making home births relatively safe were: 1) careful, strict criteria defining who is low-risk/uncomplicated, 2) caregivers who recognized complications early and transferred early when they occurred and 3) a collaborative relationship with physicians to care for women with complications
We also found the primary causes of increased home birth mortality were: 1) post-term birth, 2) breech deliveries, 3) twin pregnancies, 4) lack of response to fetal distress, 5) hemorrhage after delivery, 6) lesser-trained attendants.
After reviewing the data, and when the direct-entry midwives assured us they planned to care only for women with normal, uncomplicated pregnancies, UMA withdrew its opposition to the original bill, which passed.
Unfortunately, during the rules process to define "normal, uncomplicated", the direct-entry midwives proposed that they care for women who do have significant risks. UMA requested limitations to caring for normal, uncomplicated pregnancies as the law required. We met only deaf ears.
We understand some women wish to avoid a medical experience during delivery. SB243 does not prevent women from choosing home births. It merely says that licensed direct-entry midwives should stick to assisting with normal, uncomplicated childbirth.
Direct-entry midwives are requesting to be licensed for delivering in "normal, uncomplicated" cases. This puts responsibility on the state to protect the public by defining "normal, uncomplicated." This is the only intent of SB243.
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* CATHERINE WHEELER is past president of the Utah Medical Association.
